Jean M. Connors, MD

Question 4

A 56-year-old man presents to the emergency room for sudden onset of shortness of breath and is determined to have an acute PE. His family history is significant for multiple relatives with colon cancer. The patient is a marathon runner and denies any recent period of immobilization, air travel, or illness. He states that he leads a very active lifestyle and that his shortness of breath came on suddenly. The patient asks about what might have caused him to have this thrombotic event. Since the patient has an acute thrombosis, the emergency room team explains that they will refer the patient to a hematologist for a hypercoagulable workup at a later time.

One month later, you see this patient in the hematology clinic and he again asks if he has any risk factors that led to this spontaneous thrombotic event. Which of the following is the most appropriate next step in the management of this patient?

Explain that he is not obese, does not smoke, and leads a healthy lifestyle and therefore has no underlying risk for VTE

Explain that because the patientís father has colon cancer and the patient has had a spontaneous clotting event, you are concerned that the patient may have an underlying malignancy. Ask the patient whether he has undergone age-appropriate cancer screening and question him on any symptoms that could suggest malignancy

Explain that because the patient has a significant family history of malignancy and has had a spontaneous clotting event, you are concerned that he may have an underlying malignancy. Immediately send the patient for a full body CT scan to determine whether he has a malignancy

Ask the patient to return when he completes his anticoagulation therapy to discuss his risk factors